“I attribute my younger looking skin to the care and expertise of Dr. Pamela Basuk. I am extremely pleased with the fillers – Radiesse and Juvederm and the natrual looking results. It added fullness to my face, and is long lasting. I was impressed by the very special personal attention to provide the best wrinkle correction by the doctor.” – Nel, Bay Shore
Healthy young skin contains collagen that gives it volume, flexibility, and strength. As one ages, natural collagen begins to break down and volume is lost. Skin becomes damaged and thins and loses elasticity. Fat tissue is lost (remember “baby face”?). These losses of volume and elasticity results in fine lines, wrinkles, and skin laxity which is perceived as a loss of our youthful appearance: we look older.
Motivated by a desire to be more competitive and youthful in the workplace, and with the increased awareness that nonsurgical approaches can improve skin structure, women and men are developing a strong interest in cosmetic procedures to improve their appearance. Injectable facial fillers offer an excellent option in the treatment of facial aging, wrinkling and contour defects. They are a viable alternative to surgery for patients seeking a safe, minimally invasive and affordable means of maintaining a youthful appearance. Dermal fillers and injectables are now regarded as attractive alternatives to the more aggressive and more expensive surgical options which, years ago, had been the only solution.
An appropriate filler can eliminate shadows, hollows, and concavity on the face and restore the soft contours characteristic of younger skin, and provide a path for your face to return to a more youthful shape. [Any procedure entails some risk; the use of these fillers is no exception. We do know, however, that in 2008 1.6 million soft tissue filler procedures were done in the United States and, of course, that number is getting larger every year. Such a large number of successful prior procedures means patients can be confident that this process holds low risk.]
Soft tissue fillers are made from substances that can be injected into the skin to counteract the appearance of aging and help reduce fine lines and wrinkles. They can also be used to give more volume to lips, fill a hollow in the cheeks, improve scars and facial imperfections, and help to elevate deep facial folds. The result is a more youthful appearance which does not involve surgery or cutting of the skin, thus minimizing risk. Before facial fillers became available, the only remedy for loose, aging skin was to pull the skin taut over the remaining muscle, fat, and bone. This procedure, a “face lift”, requires general anesthesia, and the cutting necessarily results in scarring, often hidden behind the ears or under the hairline.
A variety of fillers is now available to help achieve this goal of apparent skin rejuvenation. Different filler substances address a wide range of cosmetic flaws, each bringing subtle benefits. The original fillers were “collagen” based and were derived from bovine (cattle) sources. Then human based collagen entered the market, as did autologous (one’s own) fat. The number of available fillers has greatly expanded and now include hyaluronic acid fillers, and calcium hydroxyapatite, among others.
Hyaluronic acid products are nearly identical to the hyaluronic acid naturally found in the body. It naturally occurs in the skin, cartilage, joints and the eye. In skin tissue, hyaluronic acid fills the space between collagen and elastin fibers. The role of hyaluronic acid in skin is to deliver nutrients, hydrate the skin by holding in water, and to act as a cushioning agent. Unlike use of bovine collagen, there is no need for pre-testing. Currently the hyaluronic acid fillers that Dr. Basuk prefers are Juvederm, Restylane and Belotero. Each can last anywhere from 6-12 months.
Calcium hydroxylapatite filler (market name: Radiesse) replenishes volume and stimulates the production of your own collagen. This has been shown in numerous studies to last one year or more. This compound is normally found in teeth and bone: no prior skin testing is necessary.
Which filler is best for me? There are many variables that must be considered. For example, areas with strong and frequently moved muscles, such as the nasolabial folds and marionette lines, do better with a more durable product that is not as easily broken down as hyaluronic acid fillers. Sometimes two different products are used together to achieve superior results: a denser, firmer dermal filler may be used as a base, with the more fluid fillers used to complete the correction closer to the skin’s top surface.
We can discuss the best filler options for a large variety of problems. Dr. Basuk has over 25 years of experience in corrective and cosmetic dermatology. She can discuss the various fillers, what they will accomplish, and the potential advantages and disadvantages of each.
How will I look after my treatment? Following your treatment, you may immediately return back to daily activities, however, treatment sites may be somewhat swollen for a few days. There is also potential for bruising at the injection site, which may be covered with makeup. A cooling gel and ice will be applied to your skin after the procedure.
Are there any possible risks? Any precautions I should take? All medical and cosmetic procedures carry some risks. However, soft tissue fillers are considered safe and effective. Side effects are few and are due to the local injection; allergic reactions are rare so no skin testing is necessary prior to the procedure. Alcohol, certain medications and certain herbal supplements may increase bleeding and should be avoided. Such medications include aspirin, Plavix (clopidrogel), Coumadin (warfarin), Heparin, Xarelto (rivaroxaben), Eliquis (apixaban), Pradaxa (dabigatran) and/or Lovenox (enoxaparon). Also notify your doctor if you are using any of the following vitamins or supplements: Vitamin E, omega-3 fatty acids (fish oils), dong quai, echinacea, Feverfew, flaxseed oil, garlic, ginger, ginkgo, ginseng, or papaya. Unless you have permission from your prescribing doctor, please do not refrain from taking your prescription medications in order to qualify for fillers! The most common side effects of fillers are mild swelling, bruising, erythema, and occasional pain, all of which typically resolve spontaneously within one to two weeks after injection. After getting fillers, most patients can return to work the same day.
The injection of dermal fillers consistently deliver what our patients want:
- Good results
- Minimal or no discomfort during or after the procedure
- Rapid recovery
- Minimal or no complications.
What is in the future for fillers? Advances in materials, technology, and methodology have transformed the injection of soft tissue fillers to a practical, safe, and effective protocol for restoring lost volume to the face. The number of surgical procedures has decreased as these newer means of restoring facial volume has increased. This has greatly benefited patients, yielding cost savings, less downtime, and decreased side-effects after the procedure. Because safety is our prime concern when performing any procedure, we have said goodbye to collagen based fillers. Even as we write this, there are a number of new fillers in the pipeline (being reviewed by the FDA) that may prove to be even better than what we are using now for volumizing large areas of the face while minimizing side effects. For any or all of these, we look forward to discussing these procedures with you in consultation in our office.